Iatrogenically Displaced Renal Calculus During Percutaneous Lithotripsy That Mimicked Duodenal Perforation by Resembling Leaked Oral Contrast

Percutaneous lithotripsy (nephrolithotripsy) is an interventional procedure in which renal calculi are removed from the kidney through a tube which is inserted percutaneously. The procedure removes the necessity of surgery, but still bears the risk of certain complications, including displacement of calculi or their fragments. We present a 56-year-old female patient who was brought to the radiology department with the suspicion of duodenal perforation. The patient had undergone a percutaneous intervention for lithotripsy, but things had gone rather unlucky and the stone had been mobilized out from its original location at the lower pole of the right kidney, by the impact of a stiff nelaton catheter tip used during the intervention. Following the intervention, she had developed an upper abdominal pain. At computed tomography (CT) obtained with oral contrast with the suspicion of a duodenal perforation, a fluid collection and a hyper-dense focus were noted at the near vicinity of the duodenum. The density was originally thought to represent extravasated oral contrast from the duodenum, but later it was found to be due to the calculus that was driven out from the right kidney during the interventional attempt to perform a percutaneous lithotripsy. Renal calculus displacement may be a serious complication of lithotripsy, leading to certain misdiagnoses including hollow-organ penetration. Care and commanding know-how of the procedure are of utmost importance in dealing with such situations. J Med Cases. 2014;5(7):408-410 doi: http://dx.doi.org/10.14740/jmc1811e